Select Committee on Health Written Evidence


Memorandum submitted by the NHS Confederation (CP 28)

  The Confederation brings together the organisations that make up the modern NHS across the UK. Our membership comprises 92% of NHS organisations across the UK. We work with our members to transform health services and health for the better. As an independent driving force, we do this by:

    —  influencing policy and public debate;

    —  connecting health leaders through networking;

    —  involving our members in our work; and

    —  representing NHS employers.

  Our evidence sets out our general views, based on feedback from a cross section of our member forums, on the current situation regarding the implementation of the proposed changes. Where appropriate, we have also included more specific comments on the questions asked.

Whether charges for treatments, including prescriptions, dentistry and optical services; and hospital services (such as telephone and TV use and car parking) are equitable and appropriate?

  1.  The current system of Prescription Charges is based on a mixture of medical need, social need and low income. This mixture potentially causes confusion and inequalities.

  2.  There are a number of anomalies relating to exemptions for particular types of patient that need to be addressed to make the system simpler and more obviously fair:

    —  Conditions for which exemptions do not apply include asthma, Chronic Obstructive Pulmonary Disease and Chronic Heart Disease, which can be just as much a threat to a patient's health as those which are exempt from charge.

    —  Exemptions apply to all prescriptions a patient may receive rather than being specific to a medical condition. It may be more equitable to make only the long-term medical condition for which a patient is being treated exempt rather than all the prescriptions that a patient may be issued with for un-associated acute conditions.

    —  The exemption from charge for medical treatment is not linked to income in the case of pregnancy, which may not necessarily present as much a risk to the mother's or infant's health as it did in the past.

  3.  Patient's clinical care may be affected by the associated prescription charges, as they may be put in a position whereby they are inappropriately having to restrict the treatment they are receiving on the grounds of cost.

  4.  Prescription charges are usually defined by each item prescribed on a prescription form. Certain multiple packs do exist which give rise to multiple charges, for example, helicobacter pylori irradiation therapy and many of the hormone replacement therapies. Although presented as a single patient pack, they represent a course of treatment consisting of a variety of different drugs, for which there is a charge for each different preparation (up to a maximum of three charges). Similar circumstances can arise from the prescribing of certain forms of equipment.

Whether the system of charges is sufficiently transparent?

  5.  Transparency is an issue. Patients are often unaware of the prescription charge until they are put in a position where they need a medical treatment. They also often associate the charge with profit being made with whoever dispenses the prescription, rather than recognise it as a usage charge similar to a tax.

Whether charges should be abolished?

  6.  Charges do generate income that would need to be replaced from other sources or, given the current state of public finances, found by reducing other types of services. The benefit of a reduction in charges may be less than the negative impact on other users of services. The effect of this on inequalities would need to be considered carefully.

  7.  Our members have not indicated that the costs of administering charges, verifying exemptions, collecting cash, recovering bad debts and auditing the system are a major issue for them and so, whilst there may be some savings if no charges are made, it is not clear that this would be a significant amount.

  8.  A significant reason why co-payment is used in other healthcare systems is to control utilisation and create a sense of responsibility to avoid the problem of inefficient over-consumption of healthcare. To do this, charges need to apply universally and be low enough not to deter appropriate use. The evidence seems to suggest that whilst charges can reduce inappropriate use, they may also deter patients from making appropriate use of services. The UK has a low rate of costs being a factor or being the main reason why patients do not fill their prescriptions.

Anna Scott-Marshall

NHS Confederation

December 2005





 
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